The recent Apple event was pretty tame compared to past years, with three new iPhones and Watch announced. Overall, a lot of this news had been floating around for the past few days before the event, but one item that caught my attention was the integration of an EKG sensor into the Series 4 Apple Watch.

Indeed, the event did highlight a bunch of new health features of the Apple Watch, including a bigger size and such, but two health items caught my attention:

1. ECG - A 30s ECG is being added after FDA approval to the Apple Watch that can detect arrhythmia’s (more specifically A. Fib). This is perhaps the biggest item being discussed in the Apple/Digital health field at the time, which I’ll go into detail further along.

2. Fall Risk - If you fall, the Apple Watch will allow you call for medical aid, and if no response is logged after 60 seconds. Now, I love this to a certain point. I think it’s going to be a good feature for those that want to enable it - and could be something recommended for patients at a high fall risk. It is a timely feature, given the recent acquisition of GreatCall by BestBuy lately, so Apple is definitely paying attention to how to leverage its device for services.

3. Expanded App Design - Some of the images released of how the Apple Watch can display data integrated with mobile apps for health-related purposes were really cool I thought, such as Dexcom CGM and Clue period tracker. Really nice interfaces that I think can help remind users to engage in their use, which often seems forgotten and leads to drop off for most of these health apps.
   
   

Now, before we jump in and say this is a brand new thing, I want to call attention to the fact that the Series 3 did have something similar, as so elegantly shown by Dr. Topol on Twitter.

So, this isn’t necessarily new, perhaps some of the tech inside and design. But the issues of having the Apple Watch serve as an ECG device for consumers, and being marketed as such really draws attention to what ramifications the health space may face.

While I love digital health, and really love this process, I can definitely relate to some of the issues clinicians have been weighing in on related to this issue.

And perhaps my favorite:

So what’s going on? I mean, we see many media saying this is a fantastic step, which I agree with, so why all the negativity from the medical space? Do they see it as a threat? I would say no, it’s a move in the right direction (and inevitable) but some fears related to its rollout. After all, the odds are young healthy people will be using this a lot, and we never aimed to do this type of clinical work in that age group. Even the USPSTF has recommended not to do this in such a population. So data wise this is going to be a learning process. That leads to issues of sensitivity and specificity, and the concern related to false-positives related to users being told they have an issue when they don’t.

Moreover, that's the rub. The one big thing behind digital health is it's supposed to expand clinical access to tools to patients wherever and whenever, and ideally clean up the junk in the clinical workflow nowadays seen by many in the health space. So then we have this new device arrives on the field which many see as a potential tool that could lead to more possible problems and clog up the workflow with even more cases of non-needed urgency. However, I think these are the growing pains of such a technological healthcare environment, and we’ll have to wait and see what the research shows or perhaps the first case study to learn from.

After all, this stuff isn’t necessarily new. You have apps on the Apple Store that have been purported to do the same thing for years using the smartphone camera, and then AliveCor has been on the market as well. I haven’t heard too many issues from those - but then again buy-in and use of those products may not have been as highly scaled as the Apple Watch has been.

Pharmacy take away points:

• Fall Risk - For pharmacists that conduct fall risk assessment screenings or discuss this with patients, it may be worth recommending they engage in it’s use. I think this was not talked about to much in the press but really it’s like those commercials we are seeing on TV for older patients in the home, and it’s one of the only wearables I’ve seen with such a feature.

• ECG/Arrhythmia Detection - On the off chance this comes up, I really would leave the conversation with a provider discretion on this one depending on the type of patient. If a medication profile review demonstrates likely CAD/Cardiac issues then perhaps some utility there, but for a young healthy patient I see no current benefit.

In any event, I welcome your comments and thanks for reading.